Direct vision port site dissector

ABSTRACT

A direct vision dissecting port for providing safe entry into a body cavity, as well as being operative to serve as a standard port for use in laparoscopic, endoscopic or thoracic surgery. The device includes an elongated housing within which a endoscope may be positioned. The distal-most end of the device allows for viewing of tissue dissection or gripping by tissue spreaders and is operatively transitional between a closed configuration and an open, operative configuration. Transition of the tissue spreaders between the two configurations selectively cuts tissue by a spreading action in a layer-by-layer fashion while under the direct vision of the endoscope disposed therein. The port may further optionally assume an anchor configuration once positioned within the patient to enable the same to remain securely in position during the surgical procedure.

RELATED APPLICATIONS AND CLAIM OF PRIORITY

This application claims priority to, and incorporates by reference intheir entirety, co-pending U.S. patent application Ser. Nos. 10/278,621,filed Oct. 23, 2002, titled “Direct Vision Port Site Dissector” and10/278,572, filed Oct. 23, 2003 titled “Laparoscopic Direct VisionDissecting Port”.

BACKGROUND

Laparoscopic, thoracoscopic and other endoscopic procedures arewell-known, widely utilized surgical techniques that advantageouslyreduce patient recovery time due to minimal tissue damage. Generally,these surgical techniques rely upon the formation of one or morepuncture wounds through which a body cavity, such as the peritoneal orthe thoracic cavity, can be accessed. In laparoscopic surgery, once theperitoneal cavity has been entered, the same is insufflated with carbondioxide gas, typically to a pressure of approximately 15 mm Hg, followedby the introduction of an endoscopic port with inserted trocar, whichmay either be bladed or blunt. In thoracoscopic surgery, once thethoracic cavity has been entered, procedures can be performed either bythe selective deflation of the lung on the side of the operation withsubsequent placement of an endoscopic port, or by the creation of acontrolled pneumothorax by insufflation of a limited amount of carbondioxide gas through a port that is placed into the thoracic cavity whichhas an airtight seal.

In these procedures the port and cannula are essentially the same andfunction to accept by insertion a trocar for tissue penetration or anendoscope for viewing. Generally the terms laparoscope, thoracoscope,mediastinascope, arthoscope and other such viewing device will bereferred to herein using the generic term ‘endoscope’.

The endoscopic port with inserted trocar is placed into the peritoneal,thoracic or other body cavity, followed by the placement of a viewingdevice therethrough to thus provide visualization of the body cavitythus enabling the surgeon to view the surrounding organs and conduct thesurgical procedure. Advantageously, the use of such ports placed throughsmall diameter openings enables the patient to readily heal followingsurgery, and requires much less recuperation time for the patient ascompared to open surgical procedures, which typically deploy longincisions which can and frequently are deemed traumatic to the patientand involve substantially longer recuperative periods. Despite itsadvantages, endoscopic surgery as currently performed can posesubstantial risks to the patient. In this respect, it is widelyrecognized that entry into the body cavity during such surgery, due tothe procedure by which the body cavity is accessed, can cause seriousinjury, for example, to the abdominal organs, such as the spleen, liverand intestine as well as blood vessels, or to the thoracic organs, suchas the lung, heart, or blood vessels. In the abdomen, this risk is duein large part to the fact that in the unoperated abdomen, most surgeonsenter the peritoneal cavity using a Veress needle which is pushedblindly through the patient's fascia and peritoneum. The peritonealcavity is then insufflated followed by the introduction of thelaparoscopic port with inserted blunt or bladed trocar, which also ispushed blindly into the peritoneal cavity. Once positioned therein, thetrocar is removed and a laparoscope is introduced through the port tothus provide visualization within the cavity.

Problematic with such procedure, however, is the fact that the bodycavity is entered blindly on two separate occasions: first, through theintroduction of the Veress needle; and second, through the introductionof the laparoscopic port with inserted trocar, which can and on occasiondoes injure abdominal organs and blood vessels.

To the extent laparoscopic surgery is performed upon a patient that haspreviously undergone an abdominal operation, the preferred surgicalpractice is to enter the peritoneal cavity under direct vision. In thisregard, it is known that when a patient has undergone previous abdominalsurgery, the abdominal contents can become adherent to the abdominalwall, making blind placement of a Veress needle and then blind placementof the port with inserted trocar a much more risky technique.

Using a direct vision technique, the skin is incised and thesubcutaneous tissue dissected until the fascia is encountered. Thefascia is then dissected, typically by grasping the fascia with twosurgical clamps and incising the fascia sharply followed by successivelygrasping the subfascial tissue until the peritoneum is encountered atwhich point the peritoneum is opened and the peritoneal cavity isentered under direct visualization. Once entered, the laparoscopic portis then placed in the peritoneal cavity under direct vision and theabdomen insufflated with carbon dioxide gas. This procedure, however,typically requires a larger skin incision than is typically produced viathe use of the Veress needle technique, particularly with respect toobese patients, and is further more prone to gas leakage during surgery,thus requiring constant monitoring and maintenance of adequateinsufflation.

In light of such potential complications that can arise via entry intothe peritoneal cavity during laparoscopic surgery, attempts have beenmade to provide means for safely entering into a body cavity utilizingdirect visualization. Exemplary of such devices are those disclosed inU.S. Pat. No. 5,441,041, issued to Sauer, et al., entitled OpticalTrocar, issued Aug. 15, 1995, which utilizes a blade moveable between anon-deployed position and a deployed position to thus allow dissectionunder visualization of an endoscope. Such device, however, does notallow for any type of spreading of the cut tissue to enable the surgeonto see the next layer of tissue to be entered. As such, dissection isperformed without prior visualization thereof

A similar device attempting to provide direct visualization during entryinto a body cavity is shown in U.S. Pat. No. 5,569,291, issued toPrivitera, et al., entitled Surgical Penetration and DissectionInstrument, issued on Oct. 29, 1996. Such reference discloses a devicefor forming an entry into a body cavity performed under directvisualization of an endoscope. The dissecting portion of the deviceconsists of a clear plastic conical tip with elevated dissecting bladesthat is advanced into the tissue via a twisting motion. The conical tip,however, is advanced bluntly into the tissue before the same can beidentified and, as a consequence, incision of the tissue is performedwithout prior visualization. In fact, inadvertent entry into an organcannot be avoided via use of such device, and it is only after the organis entered, and hence damaged, that such matter can be appraised.Moreover, the use of clear plastic has substandard optical visualizationdue to optical properties inherent in such material, coupled with theconical shape, such that advancement of the tip fails to provide a clearvisualization as the same is advanced through tissue.

Other devices that are similar in nature include U.S. Pat. No.5,720,761, issued to Kalli on Feb. 24, 1998 entitled Visually DirectedTrocar and Method; U.S. Pat. No. 5,551,947, issued to Kalli on Sep. 3,1996, entitled Visually Directed Trocar for Laparoscopic SurgicalProcedures and Methods of Using the Same; U.S. Pat. No. 5,609,562,issued to Kalli on Mar. 11, 1997 entitled Visually Directed Trocar andMethod; and U.S. Pat. No. 5,385,572, issued to Nobles, et al. on Jan.31, 1995 entitled Trocar for Endoscopic Surgery, the teachings of all ofwhich are expressly incorporated herein by reference.

A further related surgical instrument is disclosed in U.S. Pat. No.5,354,302, issued to Ko entitled Medical Device and Method forFacilitating Intra-Tissue Visual Observation and Manipulation ofDistensible Tissues. Essentially, such device comprises an elongatedsheath having a cone-shaped distal end and inner sheath member disposedtherein within operative to cause the distal end to move tissue away tothus enable tissue to be manipulated and visualized by the inner sheathmember. While the cone-shaped distal end is operative to move tissueaway such that visualization of tissues and the like can be enhanced,such cone-shaped distal end does not provide any dissection function.Indeed, the flaps of the distal end of the cone member are flimsy innature and non-reinforced. As such, the same are ill suited forenhancing direct visualization, much less providing any type ofdissecting function. Such device is further not designed for use inlaparoscopic applications, and in particular a laparoscopic port throughwhich other instruments can be positioned and deployed.

There is thus a substantial need in the art for a system and method thatcan enable a surgeon to selectively enter a body cavity, vessel, ororgan, for purposes of performing endoscopic procedures whereby thesurgeon is provided with direct visualization during entry such thattissue separation can be visualized and organ and tissue damage can beavoided (i.e., the surgeon can see the tissue prior to dissecting thesame). There is additionally a need for such a device and system that iscapable of forming an entry into a body cavity via a skin incision nogreater than that required to admit the introduction of an endoscopicport and that also preferably forms a tight seal around the portfollowing its introduction such that gas leakage during the surgicalprocedure is minimized. Still further, there is need for such a systemand method which provide for cavity entry without prior insufflation ofgas into the cavity but can preferably have a means to insufflate thebody cavity following entry, if desired.

SUMMARY

The present invention specifically addresses and alleviates theabove-identified deficiencies. In this regard, the present invention isdirected to a direct vision port site dissector operative to selectivelyand sequentially dissect or cut through tissue by a spreading action.Dissection by spreading of tissue under direct vision of a viewingdevice minimizes damage to tissue, vasculature and organs in a patient.The direct vision port site dissector may be used to selectively dissector biopsy tissue or it may be used to position a port into a-body cavitywhich may thereafter be utilized in a variety of surgical procedures andequipment placements.

In the practice of embodiments of the present invention the terms portand cannula are essentially the same and each functions to accept byinsertion a trocar for tissue penetration or an endoscope for viewing.Generally the terms laparoscope, thoracoscope, mediastinascope,arthroscope and other such viewing device will be referred to hereinusing the generic term ‘endoscope’.

In the embodiments of the present invention the trocars may range insize from about 2.5 mm to about 24 mm, and preferably from about 5 mm toabout 12 mm. As those skilled in the art will appreciate, the presentinvention may be manufactured from a number of different of materialsincluding, without limitation, biologically compatible metals, alloys,ceramics, plastics, or elastomers.

According to one embodiment of the present invention, the tissuedissector device consists of an elongated housing having a proximal endand a distal end, the latter being operative to be inserted through askin incision made upon the patient. Disposed at the distal end of thehousing is a tissue spreader dissecting mechanism which includes one ormore tissue spreaders which are operative to extend from the distal-mostopening of the housing and selectively spread apart, or grip the variouslayers of tissue encountered as the distal-most end of the device isadvanced through the successive tissue layers and into a body cavity,organ, or vessel. Disposed within the housing is a viewing device forviewing the dissection or biopsy of tissue by the tissue spreaders asthe device penetrates through or alternatively, grasps the tissue.

The tissue spreaders are operatively coupled to the distal end of anactuator which may be a rod or cylinder which is itself operativelycoupled at its proximal end to an actuator mechanism. The actuatormechanism transmits a force through the actuator bar, rod, or cylinderwhich is coupled to the tissue spreader through a tissue spreadingdissecting mechanism. The handle or other actuator mechanism transmits aforce through the actuator extending from the proximal end of thehousing and causes the tissue spreading dissecting mechanism, and hencethe tissue spreaders, to be selectively controlled as may be necessaryfor any anatomical considerations that are visually perceived by thephysician. With respect to a handle actuator mechanism, the same ispreferably connected to an actuator coupled to the handle member, theactuator being operatively coupled to the tissue spreading dissectormechanism to the tissue spreaders and operative to cause the same totransition between a neutral position, wherein the same is maintained ina coaxial configuration relative said distal end of said housing, and anextended configuration wherein the dissecting mechanism is operative tospread apart at the distal end of the housing and thus spread aparttissue to opposed sides of the distal end of the housing.

The tissue spreading dissecting mechanism transfers force from theactuator and actuator mechanism to the tissue spreaders. For example, inone such mechanism, the tissue dissecting mechanism may transmit thisforce to the tissue spreaders by acting as a lever or ramp at the pointof contact between the tissue spreaders and the actuator cylinder. Inanother example, the force may be transmitted from the actuator rodthrough a series of pivotally connected lever arms which are themselvespivotally connected to the tissue spreaders.

Accordingly, in one embodiment, the tissue spreaders or dissector tipcomprises a pair of arcuate blade members that cooperatively define agenerally conical shape. The tissue spreaders are preferably operativeto extend from the distal-most opening of the housing and extend indiametrically opposed directions to thus produce a spreading motion thatextends beyond the opening of the distal end of the housing and thusenables a conventional viewing device to be positioned within thehousing to provide the physician with direct vision as each layer oftissue is sequentially spread apart from the advancing distal end of thedevice. To enhance the ability of the viewing device to view past thedissector tip, the dissector tip may include arcuate voids that defineapertures through which the viewing device can view into the patientwhen such arcuate blade members assume the general conical shape.

To the extent the distal end of the device comes within close proximityto an organ or other anatomical structure sought to be avoided, thesurgeon may take appropriate measures to avoid the same. Otherwise, thephysician merely advances the distal end of the device, via thesequential spreading of tissue provided by the tissue spreadingdissecting mechanism, until such time as a body cavity or organ, such asthe peritoneal cavity or the thoracic cavity, is entered. Once entered,a conventional endoscopic port is slid down the shaft of the housing andthrough the newly dissected incision into the body cavity, whichadvantageously can be viewed under direct vision. To enable the deviceto be utilized with conventional endoscopic devices and conventionalendoscopic procedures, the same will preferably be made to fit variousdiameter ports.

Thereafter, as per conventional endoscopic procedures, the body cavitymay be insufflated with carbon dioxide gas which may be channeledthrough the endoscopic port. In an alternative embodiment of the housingof the present invention, the housing may include a dedicated carbondioxide channel to thus enable insulation of the body cavity to beachieved directly with the dissecting device and prior to the sliding ofany endoscopic port into the body cavity.

One embodiment of the present invention provides a direct vision portsite dissector that allows a surgeon to dissect a tissue under directvision and controls penetration of the device such that inadvertentdissection of an organ, blood vessel or tissue mass can be avoided orsubstantially minimized.

Another embodiment of the present invention is a direct vision port sitedissector that positions a port in a manner that simultaneously allowsfor tissue dissection coupled with port positioning and placement in amanner that substantially minimizes any possibility of leakage of carbondioxide once the same in administered to insufflate a body cavity.

According to another embodiment, the invention consists of a portdefined by a long tubular section having a proximal end and a distalend, the latter being operative to be inserted through a skin incisionmade upon the patient. The distal end is formed from a substantiallytransparent material and is operatively transitional between a firstclosed configuration wherein said distal end forms a closed, generallyconical shape and a second expanded configuration wherein said tip ischaracterized by a plurality of outwardly extending tissue spreadersspreading radially outward relative the elongate tubular section. In apreferred embodiment, the distal end is biased to assume the closedconfiguration, and may include an additional structure such an elasticrecoil or rubber covering to bias the tip to maintain the closedconfiguration.

Still further objects of the present invention are to provide a directvision port site dissector or direct vision dissecting port that, inaddition to substantially minimizing the risk of internal organ injury,is of simple construction, easy to use, relatively inexpensive tomanufacture, and can be readily deployed utilizing conventionalendoscopic surgical devices and related techniques. The device shouldalso have a means to secure the endoscope into the device to maintainconstant visual orientation and prevent the scope from slipping out ofthe device during dissection.

Another embodiment of the present invention includes the incorporationof electrodes into the tissue spreaders, arm members, and blade membersof the dissector. The electrodes may be used for electrocautery oftissue which is being dissected.

DESCRIPTION OF THE DRAWINGS

In part, other aspects, features, benefits and advantages of theembodiments of the present invention will be apparent with regard to thefollowing description, appended claims and accompanying drawings where:

FIG. 1 is a cross-sectional view of a direct vision dissecting portconstructed in accordance with an embodiment of the present invention asutilized to gain entry into a body cavity of a patient, the dissectingport further having disposed therein an endoscope or other viewingdevice to enable entry into the body cavity to be viewed by a physician;

FIG. 2 is a cross-sectional view of the dissecting port of FIG. 1wherein the distal end thereof is shown in an operative, dissectingconfiguration;

FIG. 3 is a frontal view of the distal-most tip of the dissecting portof the present invention constructed in accordance with a preferredembodiment;

FIG. 4 is a frontal view of the distal-most tip of the dissecting portof the present invention constructed in accordance with a preferredembodiment;

FIG. 5 is a perspective view of the distal end of the dissecting port ofthe present invention constructed in accordance with another preferredembodiment and assuming a neutral, closed configuration;

FIG. 6 is a cross-sectional view taken along line 6-6 of FIG. 5;

FIG. 7 is a perspective view of the distal tip of the dissecting port ofthe present invention constructed in accordance with another preferredembodiment, the distal tip being shown assuming a neutral, closedconfiguration;

FIG. 8 is a cross-sectional view taken along line 8-8 of FIG. 7, thedistal tip being utilized to gain access into the body cavity of apatient;

FIG. 9 is the cross-sectional view of FIG. 7 wherein the distal tip isshown assuming an operative, dissecting configuration;

FIG. 10 is a cross-sectional view of a direct vision port site dissectorconstructed in accordance with the preferred embodiment of the presentinvention as utilized to gain entry into a body cavity, vessel, or organof a patient, the port dissector further having included therein anendoscope, or other viewing device to enable entry into the body cavityto be viewed by a physician;

FIG. 11 is a perspective view taken along line 11-11 of FIG. 10;

FIG. 12 is a cross-sectional view of an endoscopic port being positionedto gain access to a body cavity, vessel, or organ of a patient via thedirect vision port site dissector of the present invention, the latterbeing withdrawn therefrom;

FIG. 13 is a view of the dissector tip taken along the line 13-13 ofFIG. 12;

FIG. 14 is a side-view of a dissector tip of the direct vision port sitedissector of the present invention, constructed in accordance with apreferred embodiment, shown in a second operative position;

FIG. 15 is a side view of the dissector tip of FIG. 14 shown in a firstneutral position;

FIG. 16 is a frontal view taken along line 16-16 of FIG. 15.

DETAILED DESCRIPTION

The detailed description set forth below is intended as a description ofthe presently preferred embodiment of the invention, and is not intendedto represent the only form in which the present invention may beconstructed or utilized. The description sets forth the functions andsequences of steps for constructing and operating the invention. It isto be understood however, that the same or equivalent functions andsequences may be accomplished by different embodiments and that they arealso intended to be encompassed within the scope of the invention.

It must also be noted that as used herein and in the appended claims,the singular forms “a”, “an”, and “the” include plural reference unlessthe context clearly dictates otherwise. Thus, for example, reference toa “cell” is a reference to one or more cells and equivalents thereofknown to those skilled in the art, and so forth. Unless definedotherwise, all technical and scientific terms used herein have the samemeanings as commonly understood by one of ordinary skill in the art.Although any methods and materials similar or equivalent to thosedescribed herein can be used in the practice or testing of embodimentsof the present invention, the preferred methods, devices, and materialsare now described. All publications mentioned herein are incorporated byreference. Nothing herein is to be construed as an admission that theinvention is not entitled to antedate such disclosure by virtue of priorinvention.

In the description of the present invention and embodiments thereof; theterms port and cannula may be used to describe the same device used inlaparoscopic, thoracoscopic and other endoscopic surgical procedures. Inthese procedures the trocar or endoscope may be inserted into either theport or cannula, the trocar being used for tissue penetration andendoscopes for viewing. For purposes of this invention, the termslaparoscope, thoracoscope, mediastinascope, arthoscope and other suchviewing device may be referred to using the generic term endoscope.

Referring now to the drawings, and initially to FIG. 1, there is shown across sectional view of a direct vision dissecting port 10 deviceconstructed in accordance with an embodiment of the present invention.As illustrated, the dissecting port device 10 comprises an elongatehousing 12 having a substantially transparent or non-opaque distal end12 a. The housing may be any shape, such as but not limited to square,rectangular, or triangular channels. Preferably the housing is tubular.The housing is operative to be inserted within an incision formed uponthe skin 28 of a patient and a proximal end 12 b through which a viewingdevice 16 and/or other surgical instruments may be deployed during aconventional endoscopic or other such surgical procedure. Substantiallytransparent materials, including but not limited to biologicallycompatible plastics, glasses, minerals and ceramics, permit viewing ofthe tissue at the distal end of the device. Viewing device 16 of thepresent invention may include but is not limited to endoscopes,laparoscopes, thoracoscopes, arthroscopes, endovascular scopes, oracoustical devices. Such viewing devices may also further comprise butare not limited to lenses and filters for magnification and viewing.Along these lines, viewing devices (e.g. as shown by viewing device 16)are well-known in the art and are typically provided with an eyepiece 16a on the proximal end thereof to enable the surgeon 18 to view surgicalprocedures.

According to the present invention, however, the viewing device 16further enables the surgeon 18 to view the dissecting procedure utilizedto gain access into a body cavity 36. For purposes of this invention abody cavity may include but is not limited to the peritoneal cavity,thoracic cavity, the mediastinum, the gastrointestinal tract, urinarytract, blood vessels, and structures inside the cranium. The dissectingport device 10 of the present invention not only is capable ofdissecting through tissue under direct vision and serving as aconventional port, but may be used to access tissue and various organsfor biopsy of such tissue or insertion of tubes for feeding or cablesfor other surgical devices.

With respect to the dissecting capability of the dissecting port 10 ofthe present invention, there is provided a handle member 14 formed uponthe tubular housing or port 12 and a second handle member 22, the lattercoupled with a cylindrical sleeve-like actuator 20 disposed within thelumen of the tubular housing or port 12. Handle members 14 and 22collectively define an actuator mechanism capable of being selectivelycompressed and released as shown in FIG. 1 and FIG. 2.

The actuator mechanism may be located anywhere along the housing,preferably it is located along the proximal end of the housing.Alternately compressing and releasing the actuator mechanism or handlemembers 14, 22 transmits force through the actuator 20 to the tissuespreaders or flap members 26 and facilitates the ability of thedissecting port device 10 to selectively dissect through tissue. In anoptional embodiment, a spring member 24 is disposed between handlemembers 14, 22 of the actuator mechanism to thus cause the handlemembers 14, 22 to remain in a biased state away from one another. Otheractuator mechanisms may include but are not limited to screw or geardrives, magnetic, electromechanical, pneumatic or other mechanisms knownto those skilled in the art. For example, it is contemplated that thecylindrical actuator 20 may take any of a variety of forms and maycomprise an annular member formed on the distal end of an actuator baror a retractable wire coupled to wire or spring mechanism 38 such thatactuation of the handle members 14, 22 causes wire or spring 38 to causetissue spreaders or flap members 26 to transition between closed andoperative configurations. In a further optional embodiment, handlemember 14 will have a latch 14 a formed thereon and second handle member22 will have a recess 22 a formed thereon for engaging with the latch 14a to thus enable the same to remain in a locked configuration, as shownin FIG. 2. Advantageously, the ability of the handle members 14, 22 tointerlock with one another facilitates the ability of the dissectingport device 10 to become anchored in position, as may be desired whenthe port is utilized in the performance of a surgical procedure.

The distal end 12 a of the port 12, in addition to being transparent, ischaracterized by a plurality of tissue spreaders or flap members 26 thatare operative to assume a first closed configuration, as shown in FIG.1, whereby the tissue spreaders 26 collectively define a closed endhaving a generally conical shape, and a second, opened and operativeconfiguration, shown in FIG. 2, whereby the tissue spreaders or flapmembers 26 radially spread out in the direction indicated by the letter“A”. The number of tissue spreaders or flap members may be any numbergreater than two. Handle members 14, 22 facilitate the ability of thedistal end 12 a to selectively transition from the closed configurationdepicted in FIG. 1 to the open configuration depicted in FIG. 2. In thisregard, and further illustrated in FIG. 1 and FIG. 2, by compressingactuator mechanism handle members 14, 22, cylindrical actuator 20 iscaused to advance distally within the tubular housing 12 such that thedistal end 20 a of cylindrical actuator 20 internally abuts the tissuespreaders or flap members 26 such that the same are caused to flareoutwardly as shown. By retracting the actuator or actuator cylinder 20abutting the tissue spreaders or flap members 26, the tissue spreaders26 resume their first neutral or closed configuration. The transfer offorce from the actuator cylinder 20 to the tissue spreader flap members26 by the abutment, ramping, or leveraging action of 20 constitutes thetissue spreading dissector mechanism.

Along these lines, in any embodiment the outward expansion of the flapmembers 26 causes the tissue surrounding the distal end 12 a of the port12 to become spread apart as the distal end 12 a of the port 12 isadvanced deeper within the patient. In this regard, the distal end 12 awill be positioned through an incision made through skin layer 28 withthe tissue spreaders or flap members 26 being utilized to sequentiallyspread through subcutaneous fat layer 30, fascia 32, serous membrane 34and ultimately into a body cavity 36.

Advantageously, the dissecting port device 10 of the present inventionallows layers of tissue to be selectively penetrated or grasped forremoval or biopsy under direct vision by the surgeon. The dissectingport device 10 may be used to biopsy tissue by withdrawal of viewingdevice and sampling of the tissue within the distal end of the port andclosed flap members 26. The device thus enables selective entry intovarious tissues, body cavities, vessels, and organs to be achievedwithout the risk of damaging underlying or adhering tissues which canand does occur as per conventional practice. The spreading action of thedevice also permits selective dissection of tissue adjacent to neuraland brain tissue to be made without lesions being made to the delicateneural and brain tissue.

To better enable the tissue spreaders or flap members 26 to expandoutwardly, and hence spread apart and progress through the tissue, thesame may be formed to have a progressively thicker wall thickness asdepicted in FIGS. 7-9. As illustrated in FIG. 7, tissue spreaders orflap members 26 have wall thickness that gradually increases toward thedistal end 12 a of the port 12. The gradually increasing wall thicknesstoward the distal ends of the tissue spreaders or flap members 26 enablethe same to more readily spread apart as the actuator sleeve 20 isadvanced. In use, an endoscope or other viewing device 16 is positionedwithin the port 12 and provides the physician with direct vision as eachlayer of tissue is sequentially spread apart by the advancing distal endof the device as illustrated in FIGS. 8 and 9. As would be known tothose skilled in the art, materials useful for various components of thepresent invention such as the housing, actuator mechanism, and endoscopeinclude but are not limited to biologically compatible metals such assurgical steels and titanium, as well as biologically compatiblepolymers, ceramics, and elastomers.

Because the tissue speader or flap members 26 will be formed from atransparent material, the same will not hinder or otherwise obstruct theability of the viewing device (not shown) to view the tissues layingjust beyond the advancing distal end. Suitably transparent, biologicallycompatible, and flexible materials useful for the flaps 26 may includebut are not limited to fluoropolymers such as MFA and PFA, Teflon AFfrom DuPont and Ausimont as well as various polycarbonates.

As depicted in FIGS. 8 and FIG. 9, in use the distal end 12 a of thehousing will be inserted into and cut through the various layers of skinand soft tissue 28-34. To achieve that end, the distal end 20 a ofcylindrical actuator 20 will be sequentially advanced to the distal end,as illustrated in direction “C” of FIG. 9, to cause tissue spreadingdissector mechanism flap members to spread apart along slit 40, thelatter shown in FIGS. 7 and 8. As will be recognized, due to theincreased wall thickness of flap members 26, there is thus provided amore rigid and durable abutment surface upon which distal end ofcylindrical actuator 20 a may contact. Moreover, such increased wallthickness will advantageously allow tissue spreading dissector mechanismflap members 26 to more forcefully and accurately dissect through thevarious layers of tissue 28-34.

As will be appreciated by those skilled in the art, the tissue spreadersor flap members 26 may either be blunt or, alternatively, have atexturized or serrated outer surface (not shown) to facilitate theability of such tissue spreading dissector mechanism flap members 26 tospread apart the tissue, or alternately grip tissue as for a biopsy. Inthis respect, any of a variety of texturized or sharpened objects may beformed upon the tissue spreaders or flap members 26 to facilitate theability to cut through, grip, and spread apart tissue as the same assumethe operative configurations shown in FIGS. 1 and 2 and FIGS. 8 and 9.Moreover, as shown in FIGS. 5-7, the flap members 26 may be formed tohave a longer length, defined by elongate slits 40, to thus enable theflap members 26 to extend outwardly a greater distance, as may bedesired in certain applications.

Along these lines, in order to better facilitate the ability of thetissue spreaders 26 of the distal end 12 a of the tubular housing 12 toforcefully spread such layers of tissue, it is contemplated that a wire,spring, or metal reinforcement 38 may be embedded within the tissuespreaders 26 to thus provide the same with greater structural rigidity.As illustrated in FIGS. 5 and 6, such wire, spring, or metalreinforcement 38 may take any of a variety of forms, including aplurality of distally-extending leaf springs emanating from tubularsection 38 a, which are operative to bias distal end 12 a of the housingin the closed configuration as shown.

It is also contemplated that such wire or spring reinforcement 38 may beconfigured such that the same bias flap member 26 to assume the closedconfiguration or, alternatively, lock flap members 26 in the openedconfiguration to thus serve as an anchoring effect. In this regard, itis contemplated that such open configuration may be maintained throughthe interengagement between latch 14 a with recess 22 a of the handlemembers 14, 22, as depicted in FIG. 2. By assuming such openconfiguration and remaining anchored into position, the dissecting port10 of the present invention can remain securely in position throughoutthe surgical procedure which is ultimately performed. As will beappreciated by those skilled in the art, by remaining more securely intoposition, the port enables the physician to more accurately perform asurgical procedure, and/or maintain a more reliable field of view viathe viewing device 16 utilized therewith. Optionally a collar may beprovided around port tube 12 for positioning against skin 28 to provideadditional stability of the port housing in the patient.

In accordance with an alternative embodiment of the present invention,an elastic sheath (not shown) which may alternatively take the form ofan outer rubber band, rubber sleeve or the like can be used toadvantageously cause the flap members 26 to assume the closedconfiguration shown in FIG. 1 and further present and or minimize tissuefrom being caught between tissue spreaders or flap members 26.

It is desirable that the distal end 12 a of the tubular port housing 12provide a window for the physician to directly view the dissectionprocess as the tissue spreaders or flap members 26 selectivelytransition between closed and operative configurations. In this way, thephysician is able to see each layer of tissue in advance of itsdissection and is able to avoid puncturing or otherwise damaging organs,vessels or other structure. Of further advantage is the fact that as thedissection procedure occurs, the port 12 is also being caused to form asnug fit about the tissue as the same is cut thereby. As a consequence,the dissecting port 10 is capable of being secured within the bodycavity 36 in a snug manner that can advantageously eliminate orotherwise substantially minimize any leakage of carbon dioxide gasultimately used to insufflate the body cavity.

Along these lines, once the dissecting device port 10 is advanced intothe newly dissected incision into the body cavity 36, the cavity 36 maybe insufflated with carbon dioxide as per conventional endoscopicsurgery. The specific endoscopic procedure may then be performed as perconventional surgical techniques. To that end it is contemplated thatthe dissecting port 10 will be specifically configured as perconventional ports. It is contemplated, however, that the dissectingport 10 of the present invention maybe configured to be readilyintegrated into other types of known medical procedures or medicalprocedures that are later developed.

Another embodiment of the present invention for spreading and proceedingthrough tissue under direct vision in a surgical procedure isillustrated in FIG. 10. In FIG. 10, there is shown a cross sectionalview of a port site dissector 50. As illustrated, the port sitedissector device 50 includes an elongate housing 52 having a distal end52 a operative to be inserted within an incision formed upon the skin 66of a patient. The housing may be any shape, such as but not limited tosquare, rectangular, or triangular channels. Preferably the housing istubular. The housing 52 has a proximal end 52 b for use in coupling witha viewing device 78 and providing means for manually manipulating thedissecting device 50. With respect to the manipulating device, a firsthandle member 54 is preferably formed upon the distal end of the housing52. A second handle member 56 cooperates with handle member 54 to definean actuator mechanism or handle capable of being selectively compressedin the direction indicated by the letter “A”. Alternately compressingand releasing the actuator mechanism, as through movement of the handlemembers 54, 56, transmits force to the through actuator 60 to tissuespreading dissecting mechanism and tissue spreaders to selectivelytransition blade members 64 and 94 between said neutral and operativeconfigurations enabling the port site dissector device 50 to selectivelydissect through tissue. In an optional embodiment, a spring member 58 isdisposed between handle members 54, 56 to thus cause the handle members54, 56 to remain in a biased state away from one another.

Actuator mechanisms may include but are not limited to springs, screw orgear drive, magnetic, electromechanical, pneumatic or other mechanismsknown to those skilled in the art. The actuator mechanism may bepositioned anywhere along the housing 52, preferably it is formed nearthe proximal end of the housing. The actuator mechanism force may betransmitted to the actuator 60 and then to the tissue spreadingdissector mechanism in various ways. The actuator 60 may be but is notlimited to rods, shafts, cylinders, or threaded rods. Attached to, orpreferably integrally formed with the actuator mechanism or handle 56 isactuator bar 60, the latter extending in general parallel relation totubular housing 52 and terminating near distal end 52 a thereof.Attached to the distal-most end of actuator bar 60 is a tissue spreadingdissector mechanism 62 operative to selectively spread tissue, via adissector tip, the latter preferably comprising diagonally extending armmembers 86, 88 pivotally connected to the distal end of actuator bar 60and an opposed pair of tissue spreaders 64, 94, more clearly seen inFIGS. 11 and 14, to thus enable layers of tissue to be selectivelyspread apart as the port site dissector device 50 is advanced throughthe various layers of tissue, for example, subcutaneous fat layer 68,fascia 70, serous membrane 72 and ultimately into the body cavity 74.Another opposed pair of tissue spreaders 100, 102, which reflect anotherembodiment of the present invention, are depicted in FIGS. 14-16.

Advantageously, the port site dissector device 50 of the presentinvention enables such layers of tissue to be selectively penetrated orgrasped for removal or biopsy under direct vision by the surgeon. Thedevice thus enables selective entry into various tissues, body cavities,vessels, and organs to be achieved without the risk of damagingunderlying or adhering tissues which can and does occur as perconventional practice. The spreading action of the device also permitsselective dissection of tissue adjacent to neural and brain tissue to bemade without lesions being made to the delicate neural and brain tissue.

To achieve that end, the device 50 is operative to receive a viewingdevice 78 within the tubular housing 52 thereof to thus provide aphysician with the ability to directly view the sequential dissection ofthe various layers of tissue via the dissector 50 of the presentinvention. As shown in FIG. 10, viewing device 78 is operativelypositioned within the tubular housing 52 such that the distal-most endof the viewing device 78 a is positioned in close proximity to thetissue spreading dissector mechanism 62 with spreader members 64, 94 tothus enable the physician to view each step of the dissection process.To facilitate the ability of the device 50 to receive the viewing device78, there may be provided a clamp mechanism 82 formed upon proximal end52 b of the housing 52, with screw lock 84 to thus enable the same to belocked into position. The clamp mechanism may also be engaged tosecurely hold the viewing device 78 into position within the lumen ofthe housing or may be disengaged to allow free rotation of the scopewithin the lumen of the housing. The locking mechanism may also bereleased for removal of the viewing device from the housing lumen tochange endoscopes or to perform cleaning on them. There may additionallybe provided an abutment apparatus or other type of engagement mechanism52 c formed with the lumen of housing 52 to prevent the distal end 78 aof the viewing device from extending beyond distal end 52 a of thehousing. Once secured into position, the eyepiece provided on theproximal end 78 b of the viewing device, as per conventional endoscopes,enables the surgeon to see and directly view the dissection procedure.

As further shown in FIG. 10, the device 50 is operative to be axiallyreceived within the lumen of a conventional endoscopic port 76 such thatonce access into the body cavity has been safely achieved, the port 76may be secured into position so that the subsequent surgical proceduremay be performed. Referring now to FIGS. 11 and 13, and with initialreference to FIG. 11, there is shown the means by which tissue spreadingdissector mechanism 62 is operative to cause the dissector tip, namely,tissue spreader members 64 and 94, to selectively dissect through thevarious layers of tissue to gain access to the body cavity, organ, orvessel. As is shown, when actuator bar 60 is retracted in the directionindicated by the letter “B”, which occurs through compression ofactuator mechanism or handle members 54, 56, diagonally extending armmembers 86, 88 pivotally connected to the distal end of actuator bar 60are operative to rotate inwardly as indicated by the direction “C”. Asecond pair of arm members 90, 92, pivotally connected to arms 86, 88,respectively, are then consequently operative to rotate outwardly fromthe distal—most end 52 a of tubular housing 52, as indicated by thedirection “D”, to thus cause tissue spreader members 64, 94 to spreadapart, separate, cut through, and move tissue away therefrom. In thisregard, the tissue spreaders 64, 94, will be operatively transitionablebetween a first neutral configuration or position, as shown in FIG. 13,whereby the same are contained within the diameter defined by the distalend 52 a of the tubular housing 52 and an operative configuration,whereby the tissue spreader members 64, 94, may extend to or beyond thecircumference defined by the distal end 52 a of the tubular housing 52to thus spread apart the tissue as the distal end 52 a of the tubularhousing 52 is advanced deeper within the patient.

In use, the device 50 is utilized to sequentially spread layers oftissue 68, 70, and 72 until such time as the body cavity, vessel, ororgan is accessed or a tissue for a biopsy is removed. As illustrated inFIG. 12, the device 50 is shown with endoscopic port 76 just enteringthe serous membrane. To achieve that end, tissue spreaders 64, 94, willpreferably comprise arcuate blade members that cooperatively define agenerally conical-like structure when the same assume the neutralposition, as shown in FIGS. 11 and 13. When the spreader members 64, 94assume the operative configuration, the same will extend indiametrically opposed directions to thus cause the tissue to bedissected in an outwardly-extending direction relative to the distal end52 a of the housing 52. Tissues spreaders, for example but not limitedto those like 64 and 94, are advantageous for penetrating delicate braintissues or body cavity walls with adherent organs because their edgesmay be suitably shaped to slowly penetrate the tissue and minimizecutting or lesioning of underlying tissue and organs.

Such mode of tissue penetration action is further illustrated, forexample, in FIGS. 14-16 with respect to alternatively configured tissuespreaders 100, 102, of the dissector tip. As shown in FIG. 14, thetissue spreaders 100, 102, are shown in the operative position wherebythe same extend in diametrically opposed directions from the distal endof the tubular housing 52. Tissue spreaders, for example but not limitedto those like 100, 102, and in contrast to the embodiment depicted inFIGS. 10-13, are provided with serrated edges 104, as may be desired tofacilitate the ability of the tissue spreader 100, 102, to advancethrough tissue.

The tissue spreaders 100, 102, may further be provided with arcuatevoids 106, 108, that cooperate to define generally circular oroval-shaped apertures when the tissue spreaders 100, 102, assume theneutral position, as shown in FIG. 15. Advantageously, by providingarcuate voids 106, 108, which define such apertures, there is thusprovided channels or access by which a viewing device 78 (not shown) candirectly view the tissue directly ahead of the dissector tip while thetissue spreaders 100, 102 assume a neutral position as shown in FIGS. 15and 16.

It will be appreciated by those skilled in the art that althoughdepicted as semi-circular blade members, tissue spreaders 64, 94, 100,102 may take any of a variety of configurations known in the art, andmay include any of a variety of tissue spreading mechanisms includingadditional tissue spreader members. A number of shapes, sizes, orconfigurations of the dissecting tip may be used in the presentinvention without limitation as would be obvious to one skilled in theart. The shape, size or configurations of such tissue spreaders ordissecting tips will be chosen based upon its suitability for particularoperation or procedure with consideration given to but not limited totissue type and depth to be removed, underlying tissue or organ,required port size. In all cases, however, it is desired that the tissuespreaders be operative to sequentially spread layers of tissue out ofthe field of vision to be observed by the distal end 78 a of theendoscope or other viewing or recording device 78 to thus enable thephysician at all times to see the tissue, during both when the tissuespreader members assume either the neutral or operative configurationsuntil such time as the endoscopic or other such port 76 is advanced intothe channel formed by the dissection of tissue by the tissue spreadersand the device 50 removed therefrom, as shown schematically in FIG. 12.

As would be known to those skilled in the art, materials useful forvarious components of this embodiment of the present invention such asthe housing, actuator mechanism, tissue spreaders, arm members, andendoscope include but are not limited to biologically compatible metalssuch as surgical steels and titanium, as well as biologically compatiblepolymers, ceramics, and elastomers.

At all steps during the procedure the distal end 78 a of endoscope, orother viewing device 78 is operative to provide the physician with adirect view of the dissection process as the tissue spreader members 64,94, or 100, 102 selectively transition between their neutral position,and the operative tissue spreading configuration. As such, at all times,the physician is able to see each layer of tissue in advance of itsdissection and is able to avoid puncturing or otherwise damaging anorgan, vessel or other structure. Of further advantage is the fact thatthe dissector 50 of the present invention is operative to spread aparttissue as the distal end 52 a of the housing 52 is advanced axiallydownward. As a consequence, a snug fit is formed about the tubularhousing 52, which in turn provides for a snug fit about the port 76 oncethe same is ultimately secured into position, as shown in FIG. 12.

As will be recognized by those skilled in the art, the dissector 50 maybe used to biopsy a tissue and enables the physician to avoid injuringadjacent organs, vessels, nerves, and the like. The dissector may alsoenable the port 76 to be secured into position with the body cavity in asnug manner to advantageously eliminate or otherwise substantiallyminimize any leakage of carbon dioxide gas ultimately used to insufflatea body cavity or to seal about tubes or other feedthroughs for use by asurgeon. In this respect, not only will entry into the body cavity beentered in a manner that avoids any risk to organs, vessels, and thelike, it likewise enables a port to be placed into position without theneed to provide any sort of prior insufflation.

Once the port 76 is advanced into the newly dissected incision into thebody cavity, for example the peritoneal or thoracic, the body cavity maybe insufflated with carbon dioxide as per conventional surgery. Thespecific endoscopic procedure may then be performed as per conventionalsurgical techniques. Along these lines, it is contemplated that thedevice 50, and more particularly the tubular housing 52, thereof, willbe specifically configured to fit conventional ports. It iscontemplated, however, that the same may be sized and adapted to fit anyof a variety of conventional endoscopic port sizes and or adapted toreceive and be utilized with any of a variety of endoscopes or otherviewing devices to thus enable the same to be readily integrated intoconventional medical procedures.

Embodiments of the device of the present invention are designed for thesafe entry into various body cavities under direct visual dissection ofthe tissues in order to prevent inadvertent organ injury. For example,the device may be used for entry into the previously operated abdomenwith the likelihood of intra-abdominal adhesion being fairly high, assuch, it may be useful as a replacement for the Hasson technique. As themajority of significant adhesions are to the area under the previousincision, the device can be used either to enter the abdominal cavity inthe midline above or below the previous incision where organ or tissueadhesion is less likely. The device can also be used to enter theabdominal cavity in other areas such as the lateral abdominal wall wheretissue or organ adhesion is less likely. In this case the device hasdistinct advantages over the Hasson technique as the Hasson technique iscumbersome to perform when entering through the three separate layers ofthe lateral abdominal wall, requiring a larger incision and longeroperative time, while embodiments of the device of the present inventionwere designed for such entry and can be used to enter laterally via anincision no larger than that necessary to admit the endoscopic port. Thedevice is also ideally suited for entry into the unoperated abdomen aswell, avoiding the necessity of three blind phases of laparoscopic orendoscopic surgery: Veress needle insertion, insufflation, and blindtrocar insertion.

The present invention may also be used to enter the thoracic cavitythrough the pleural membrane while minimizing the risk of damage toadjacent lung tissue. As an increasing number of thorascopic proceduresare now being performed under condition of controlled pneumoperitoneum,the dissection provided by the present invention will provide a tightseal with the port ensuring minimal gas leakage which is desirable tothe completion of the procedure.

The present invention may also be used to dissect, under direct vision,and with significant magnification, vital structures, during the courseof surgery after the insufflation has been established.

Embodiments of the present invention are well suited to robotic orvirtual reality surgery as the device can rely on visual cues, ratherthan tactile sensation required for entry using other optical trocars,some of which require a great deal of force to be applied in order toenter a body cavity such as the abdominal cavity. Typically it is thesurgeon's judgment that determines when the trocar will enter theabdominal cavity. Optical methods may be used to distinguish tissuetypes being dissected by the device and may be used in a closed loopservo system with the tissue spreaders of the present invention tocontrol the rate of penetration of the device through tissues in apatient. Additionally, since the resistance of the tissue in manydissections decreases rapidly upon entry into a body cavity, forcesensors may also be used with the tissue spreaders of the presentinvention to monitor, through a controller, and ensure that the devicedoes not over-penetrate on entry to the cavity risking significant organinjury.

Embodiments of the present invention may be used safely to dissect underdirect magnified vision, any body cavity or potential space such as theperitoneal cavity, thoracic cavity, pre-peritoneal space,retro-peritoneal space or intraluminal space. Embodiments of the presentinvention may be particularly advantageous in neurosurgery or othersurgeries involving the nervous system, where small incisions in theskin overlying the skull or spine can be made and the dissection to ordissection of the structures of interest inside the cranium or near thespine can be approached under direct vision without the use of sharpdownward cutting edges.

Modern endoscopic procedures often control a patient's bleeding in thesurgical site through the use of electrocautery. As used herein, thephrases cautery, electrocautery, and coagulation may be usedinterchangeably.

Monopolar cauterization is a method of cauterizing tissue with a singleelectrified metal tip. The electricity is concentrated at the tip of theinstrument where is conducts from the instrument to the patient andcauses sealing blood of vessels as current flows to a larger groundingpad. One skilled in the art would understand how one or both of themobile tips of the port site dissector could be electrified to provideboth monopolar cautery or bipolar cautery.

Bipolar electrocautery instruments generally include two electrodesclosely spaced for contact with organs and tissue of the patient. Theelectrodes are electrically isolated from each other and include aseparate current path back through to a current connector locatedadjacent the handle of the instrument. The current connectors are inelectrical communication with a suitable power supply. Thus, duringcontact of the bipolar instrument with an organ or tissue of thepatient, electric current flows from the first electrode through thetissue which is then cauterized, and then to the second electrode of thebipolar instrument.

Embodiments of the present invention may also include electrodes forelectrocautery. The flaps, blade member, or arm member tips of thedissector may be or have incorporated into them an electrocauteryelement. The tips may be made either monopolar or bipolar by connectionto a source of electric current such that the tip of the dissector maybe used to selectively cauterize blood vessels or tissue encountered inthe dissection. For example, as shown in FIG. 10, the electrocauteryelement in the tips can be connected via a thin insulated wire (notshown) running within or inside the tube structure towards the proximalend, to an electrical connector 1 10 extending outward from the body ofthe device which would be connectable to a standard electrocautery powersource. In FIG. 10 the proximal end of the housing 52 b may be providedwith a wire which may have one or more insulated conductors fromconnector 110 within the housing 52 which electrically connects one orboth of the blade members 64 and 94 to the power supply (not shown). Thehousing 52 may include a switch (not shown) to selectively permit theoperator of the dissector to allow or stop the flow of current to theelectrodes. In FIG. 13 one or both of the arm members 90 or 92 may beelectrically energized to act as tips or electrodes for electro-cautery.Where the blade members or arm members function as an electrode theyshould be made of a chemically compatible and electrically conductivematerial. Electrically insulating gaskets may be used to isolate armmembers at their pivot points or insulating gripping members 112 and 114may be used to provide for bipolar operation of the arm members or theblade members as electrodes. A filament or electrode may be applied tothe surface or recessed into flap members 26, arm members, or blademembers and connected to a source of electric current for monopolar orbipolar electrocautery.

Embodiments of the present invention may also be used for grasping andsampling tissue since the tissue spreader jaws can be actuated forciblyinto both open and closed positions. As such, the device may used topenetrate a tissue and selectively biopsy portions of it, for exampleremoval of a polyp or cyst, during the dissection for later examinationin order to establish a precise diagnosis. This application could beused potentially in flexible endoscopy such as but not limited tocolonoscopy, upper endoscopy, and urethroscopy and ureteroscopy. Anembodiment of the present invention with suitably shaped tissuespreaders may be configured in a flexible endovascular scope, and assuch may be used for the direct angioplasty of vessels as well as otherendovascular surgeries.

Additional modifications and improvements of the present invention mayalso be apparent to those of ordinary skill in the art. For example, itis contemplated that the port dissector device 10 or device 50 mayinclude a separate port to enable the body cavity to be insufflated withcarbon dioxide, rather than requiring that the port site dissectordevice 10 or 50 be withdrawn from the body and the carbon dioxideadministered separately. In another example, actuator bar 60 may beconfigured such that separation of handle members 54, 56 causes such bar60, via tissue spreading dissector mechanism 62 attached thereto, toselectively dissect through tissue. In yet another example, device 10and port 12 may be used to initially access a body cavity and maintaininsufflation with flaps 26 closed. Thereafter viewing device 16 may beremoved and replaced with tubular housing 52, tissue dissectingmechanism 62 and blades 100 and 102 for selective biopsy of a tissuewithin the body cavity under direct vision by viewing device 16. Thus,the particular combination of parts and steps described and illustratedherein is intended to represent only certain embodiments of the presentinvention, and is not intended to serve as limitations of alternativedevices and methods within the spirit and scope of the invention.

1. A dissector device useful for dissecting a tissue comprising: anelongated housing having proximal and distal ends, said distal end beingoperative to be inserted within a surgical incision, said housingfurther being operative to receive a viewing device within the lumenthereof and orient the viewing device to view through the distal end ofsaid housing; a tissue spreading dissector mechanism formed upon saiddistal end of said housing, said tissue spreading dissector mechanismoperatively transitional between: a first neutral configuration whereinsaid tissue spreading dissector mechanism extends from the distal end ofsaid housing; and an operative configuration wherein said tissuespreading dissector mechanism extends outwardly relative to said distalend of said housing; and an actuator mechanism formed upon said proximalend of said housing operative to selectively cause said tissue spreadingdissecting mechanism and tissue spreaders to selectively transitionbetween said neutral and operative configurations.
 2. The dissector ofclaim 1 wherein said tissue spreader dissecting mechanism comprisesopposed blade members operative to extend in diametrically opposeddirections from said distal end of said housing when said tissuespreader dissecting mechanism assumes operative configurations.
 3. Thedissector of claim 2 wherein said dissector further includes a clampmechanism for securably holding said viewing device into position withinsaid lumen of said housing.
 4. The dissector of claim 3 wherein saidclamp mechanism is formed upon said proximal end of said housing.
 5. Thedissector of claim 1 wherein said housing further includes a stop memberformed within the lumen thereof for limiting the distance said viewingdevice or endoscope can extend distally within said tubular housing. 6.The dissector of claim 1 wherein said actuator mechanism is an actuatorbar operatively coupled to handle members and said tissue spreadingdissector mechanism, said actuator bar being operative to cause saidtissue spreading dissector mechanism to selectively transition betweensaid neutral and operative configurations when said handle members areactuated.
 7. The dissector of claim 1 wherein said tissue spreadingdissector mechanism comprises a first pair of arms pivotally mounted toan actuator rod and a second pair of arms coupled to said first pair ofarms and operative to pivot outwardly relative to said first pair ofarms, said second pair of arms having tissue spreader members formed onthe respective ends thereof that are operative to transition from saidneutral and operative configurations as said first and second armmembers pivotally move relative to one another.
 8. The dissector ofclaim 1 wherein said dissector further comprises a channel formedtherein for administering an insufflative gas.
 9. The dissector of claim1 wherein said dissector is capable of being axially received within aport.
 10. The dissector of claim 9 wherein said dissector is insertablethrough a port or cannula.
 11. The dissector of claim 2 wherein saidopposed tissue spreader blade members cooperate to define aconical-shaped configuration when assuming said first neutral position.12. The dissector of claim 2 wherein said opposed tissue spreader blademembers are provided with serrated cutting edges.
 13. The dissector ofclaim 2 wherein said opposed tissue spreader blade members are providedwith at least one void formed thereon defining a channel through whichsaid viewing device can view the distal end of said housing.
 14. Thedissector of claim 1 wherein the tissue spreaders of the tissuedissecting mechanism are in electrical communication with a source ofelectric current, said tissue spreader used for selectively cauterizingtissue.
 15. A dissector device useful for dissecting a tissuecomprising: an elongated housing having proximal and distal ends, saiddistal end being formed from a substantially transparent material andoperative to be inserted within an incision on a patient, said housingfurther being operative to receive and securably hold a viewing devicewithin the lumen thereof and orient the viewing device to view throughthe distal end of said housing; a plurality of flap members formed uponthe distal end of said housing, said flap members being operativelytransitional between: a first closed position wherein said flapscollectively defined a generally closed configuration; an operativeconfiguration wherein said flap members extend radially outward aboutsaid distal end of said housing; and an actuator mechanism formed uponsaid proximal end of said housing operative to selectively cause saidflap members to selectively transition between said closed and operativeconfigurations.
 16. The dissector of claim 15 wherein said flap membersinclude a metal reinforcement formed therein for imparting structuralrigidity thereto.
 17. The dissector of claim 16 wherein said metalreinforcement comprises a spring operative to bias the flap members tothe closed configuration.
 18. The dissector of claim 15 wherein saidflap members include a sharpened gripping surface formed on the surfacethereof.
 19. The dissector of claim 15 further comprising an actuatoroperatively coupled to said actuator mechanism and said flap members,said actuator being operative to cause said flap members to selectivelytransition between said closed and operative configurations when saidactuator mechanism is actuated.
 20. The dissector of claim 19 whereinsaid actuator comprises an elongated cylindrical sleeve disposed withinsaid housing and having a distal end in abutment with said flap members,said distal end of said cylindrical sleeve being operative to advancedistally within said tubular housing such that said flap memberstransition from said closed to operative configurations.
 21. Thedissector of claim 15 wherein said actuator mechanism further comprisesa locking mechanism to cause said flap members to assume said operativeconfiguration.
 22. The dissector of claim 21 wherein said lockingmechanism is formed upon the actuator mechanism of said port.
 23. Thedissector of claim 15 wherein said distal end includes at least two flapmembers formed thereon.
 24. The dissector of claim 15 further comprisingan elastic sheath formed radially about said plurality of flap memberssuch that said flap members are biased to the closed configuration. 25.The dissector of claim 15 further comprises an elastic, sheath affixedto said flap members, said sheath being operative to form a coveringabout the opening of said distal end of said housing when said flapmembers assume said operative configuration.
 26. The dissector of claim15 wherein said housing is a cannula.
 27. The dissector of claim 15wherein said housing is able to accommodate an existing endoscope. 28.The dissector of claim 15 wherein said flap members are formed to havean increased sidewall thickness extending toward said distal endsthereof.
 29. The dissector of claim 15 wherein said metal reinforcementcomprises a plurality of distally-extending leaf spring membersoperative to bias the flap members to the closed configuration.
 30. Adissector device useful for dissecting a tissue comprising: an elongatehousing having proximal and distal ends, said distal end being operativeto be inserted within a surgical incision, said housing being furtheroperative to receive an actuator and a viewing device within the lumenthereof and orient the viewing device to view through the distal end ofsaid housing; tissue spreaders formed upon the distal end of saidhousing for cutting or griping tissue and operatively connected to atissue spreader dissecting mechanism; said tissue spreader dissectingmechanism operatively transitioning said tissue spreaders between: aclosed configuration wherein said tissue spreaders collectively define agenerally closed configuration; and an operative configuration whereinsaid flap members extend radially outward about said distal end of saidhousing; and an actuator mechanism formed upon the proximal end of saidhousing and operatively connected to an actuator within said housing,said actuator operatively connected to said tissue spreader dissectingmechanism and operative to transition said tissue spreaders between saidoperative and closed configurations.
 31. The dissector of claim 30wherein said tissue spreaders are a plurality of flap members.
 32. Thedissector of claim 30 wherein said tissue spreaders are arcuate blades.33. The dissector of claim 30 wherein said housing is tubular.
 34. Thedissector of claim 30 wherein said tissue spreading mechanism comprisesa lever.
 35. The dissector of claim 30 wherein said tissue spreadingmechanism comprises a ramp.
 36. The dissector of claim 30 wherein saidviewing device is an endoscope.
 37. The dissector of claim 30 whereinsaid housing further comprises a clamp for securing a viewing device.38. The dissector of claim 30 wherein said housing further comprises aninlet for gas insufflation of a body cavity.
 39. The dissector of claim30 wherein said actuator mechanism further comprises a latch forsecuring the actuator in an operative configuration.
 40. The dissectorof claim 30 wherein the flap members of the tissue dissecting mechanismare in electrical communication with a source of electric current, saidflaps used for selectively cauterizing tissue.
 41. The dissector ofclaim 40, wherein said tissue is a blood vessel.